Journal of Intercultural Ethnopharmacology

Mini Review
www.jicep.com
DOI: 10.5455/jice.20160421125217

Trends and challenges toward

integration of traditional medicine in
formal health-care system: Historical
perspectives and appraisal of education
curricula in Sub-Sahara Africa
Ester Innocent

Department of Biological
and Pre-clinical studies,
Institute of Traditional
Medicine, Muhimbili
University of Health and
Allied Sciences, P.O. Box
65001, Dar es Salaam,
Tanzania
Address for correspondence:
Ester Innocent, Institute
of Traditional Medicine,
Muhimbili University
of Health and Allied
Sciences, P.O. Box 65001,
Dar es Salaam, Tanzania.
E-mail: einnocent@muhas.
ac.tz
Received: March 02, 2016
Accepted: April 11, 2016
Published: May 04, 2016
ABSTRACT
The population residing Sub-Sahara Africa (SSA) continues to suffer from communicable health problems such
as HIV/AIDS, malaria, tuberculosis, and various neglected tropical as well as non-communicable diseases. The
disease burden is aggravated by shortage of medical personnel and medical supplies such as medical devices
and minimal access to essential medicine. For long time, human beings through observation and practical
experiences learned to use different plant species that led to the emergence of traditional medicine (TM)
systems. The ancient Pharaonic Egyptian TM system is one of the oldest documented forms of TM practice
in Africa and the pioneer of world’s medical science. However, the medical practices diffused very fast to
other continents being accelerated by advancement of technologies while leaving Africa lagging behind in the
integration of the practice in formal health-care system. Challenging issues that drag back integration is the
development of education curricula for training TM experts as the way of disseminating the traditional medical
knowledge and practices imbedded in African culture . The few African countries such as Ghana managed to
integrate TM products in the National Essential Medicine List while South Africa, Sierra Leone, and Tanzania
have TM products being sold over the counters due to the availability of education training programs facilitated
by research. This paper analyses the contribution of TM practice and products in modern medicine and gives
recommendations that Africa should take in the integration process to safeguard the SSA population from
disease burdens.
KEY WORDS: Bantu, curricula, formal system, integration, practice, products, Sub-Sahara Africa, traditional
medicine

INTRODUCTION TM, Ayurvedic medicine, Naturopathy, Homoeopathy, and

The Contribution of Ancient African Traditional
Medicine (TM) Practices in Modern Medicine
The Sub-Sahara Africa (SSA) continues suffering from the
burden of diseases despite being a rich source of biodiversity
from which many hospital medicines have been tapped, and a
lot more are untapped. This untapped avenue has contributed
minimally in solving health problems since TM has not yet been
formally integrated into the existing conventional health-care
delivery [1]. The reasons being partly because there are few
TM curricula that are geared to trained human resources to
undertake quality services and development of materia medica
used in treatments in this region. However, different countries
or continents elsewhere have their TM practices supported by
documented material medica and the underlying philosophy for
disease diagnosis and treatments such as Unani TM, Chinese
Korean oriental medicine [2-4]. Therefore, the philosophy and
theories of disease symptoms, diagnosis, and treatment used
in African TM need to be established and learned because the
surge for the use of TM is now not limited to countries of origin
rather a trans-territory and a choice of many people even in
developed countries [5-8]. African TM practices are imbedded
in the indigenous knowledge of one’s culture or society thus
also serves as backups of what the local communities have
maintained for centuries for their survival and prosper within
their ecosystem.
In the written record, the ancient Pharaonic Egyptians medical
practices are the oldest documented form of TM practice in
Africa. From the beginning of the civilization in about 3300 BC
until the Persian invasion in 525 BC, Egyptian medical practices
were highly advanced for its time including simple non-invasive
surgery, bones setting, and an extensive set of pharmacopeia in

J Intercult Ethnopharmacol ● 2016 ● Vol 5 ● Issue 3 1

Innocent: Trends and challenges of integration of TM
the form of papyri. The Ebers Papyrus (c. 1500 BC) is among
the oldest preserved medical documents and contains some
700 magical formulas and remedies. Records show that the
diagnosis of diabetes disease was described in Ebers Papyrus as
disease of “urine pass through” [9]. The Edwin Smith papyrus
(c. 1600 BC) includes a description of simple non-invasive
surgery whereby the position of diagnosis of breast cancer and
its management is described as a “tumor do thou nothing there
against” [10]. Several other papyri collected in Egypt influenced
TM of other traditions, including the Greeks and Romans, but
later other parts of the world [11].
No much is recorded about TM practices in Africa until the
19th century when Africa was partitioned and missionaries’
works started. For example in by then Germany East Africa
and British East Africa, which compose the current East Africa
Community countries, one British traveller [12] witnessed
cesarean section being performed by Ugandan people to serve
the baby and mother. Similar reports of surgical practices were
reported from Rwanda, whereby botanical preparations were
used to anesthetize the patient to perform a cesarean and
promote wound healing [12]. In Tanzania, the German ship’s
doctor Dr. Weck, Adolf Bastian (1826-1905), W. H. R. Rivers
(1864-1922), and C. G. Seligman (1873-1940) observed and
wrote a number of diseases being managed by TM in the Hehe
community [13,14]. These few examples of ancient indigenous
practices show the significant contribution to the modern
practices of diagnosis and disease management since some
still hold to date.
TM in SSA
In Africa, the Bantu-speaking peoples make up a major part
of the population of nearly all African countries south of the
Sahara. They belong to over 300 groups, each with its own
language or dialect [15]. Despite the diverse culture and
ethnic groups in SSA, still, most societies are dominated by
the Bantu culture and believe [15]. Therefore, TM in the SSA
region is rational in the context of Bantu cultures and is like
theories in western medicine. The Bantu believes a human
being is holistic yet corporate, in terms of the family, clan
and whole ethnic group. Therefore, it is required never to
do harm to the patient unless it is in his or her best interests
or for the good of the community because if he suffers, he
does not suffer alone but with his corporate group: When
he rejoices, he is not alone but with his kinsmen, neighbors,
and relatives. In the modern health-care system, this is a
principle worth emulating; never to do harm to a patient
unless the nurse or doctor, after serious consideration, believes
that it is in the interests of the patient or it is necessary
for the protection of other patients or the public [16-18].
The African Union Commission adopted the WHO/Afro
(1976) definition of African TM as the total of all practices,
measures, ingredients, and procedures of all kind whether
material or not which guard against disease/illness to alleviate
suffering and cure himself [19]. Thus, African TM does not
regard man as a purely physical entity but also takes into
consideration the sociological (family or other), whether
2 J Intercult Ethnopharmacol ● 2016 ● Vol 5 ● Issue 3
living or dead (ancestors) and the “intangible forces” (God,
gods,) of the universe [19,20]. Thus, disease is not merely a
result of dysfunction of an organ caused by the invasion of
microscopic organisms (Germ theory) but also may be due to
intangible forces. Therefore, treatment in African TM is by
use of both material substances and resources drawn from the
cosmic world all together not separated (Holistic theory) in
an attempts to restore a state of wholesomeness using various
methods including plant remedies [19,20].
Interdependence of Traditional and Modern Medicine
The pharaonic pharmacopeia papyri described several plants
including the bark of the willow tree, in which Hippocrates
(~ 460-370 B.C.) who is acknowledged as a father of western
medicine used to control headaches and other body pains [21].
It was through chemistry, the active molecule which is salicylic
acid was identified, in 1889, and later aspirin, paracetamol,
diclofenac, mefenamic acid, ibuprofen, etc., were synthesized
based on the structure of salicylic acid [21,22]. Several other
useful hospitals medicines and vaccination, such as quinine,
ephedrine, amodiaquine, primaquine, chloroquine, mefloquine,
atropine, reserpine, digoxin, tubocurarine, metformin,
Scopolamine, taxol, and calanolide A, are now synthetically
made from a structure of an initial naturally isolated compound
from medicinal plants while others are semi-synthetically derived
from the natural product precursors [22,23]. Several medicinal
plants, such as Madagascar’s rosy periwinkle Catharansus roseus,
remain the basic source of anticancer drugs vincristine and
vinblastine [23]. This indicates the potential of medicinal plants
and its current contribution to hospital medicine, in which
most of these are an essential medicine dispensed worldwide for
treatment of different diseases. This confirms the contribution
of both modern and TM in the advancement of the current
health systems not only in SSA but worldwide.
Opportunities and Challenges to Promote TM Practices
and Products in SSA
The contribution of TM and its practitioners was recognized,
in 1978, by the Alma-Ata Declaration as important resources
in achieving health for all by the year 2000 [24]. A number
of resolutions and declarations have been adopted by the
WHO governing bodies at regional and global levels including
Resolution AFR/RC49/R5 on Essential Drugs in the WHO
African Region. The resolution required the WHO to support
Member States to carry out research on medicinal plants and
to promote their use in health-care delivery systems [25]. The
Regional Committee that adopted resolution AFR/RC49/R5
also called on the WHO to develop a comprehensive strategy on
African TM with the focus on producing evidence [25-27]. Since
then, African countries have been supporting these initiatives
in different ways such as documenting ethnobiomedical
information, scientific evidence/research, media promotion,
implementing international and national plans and policies
including the plan of action on the decade of TM for
(2001-2010) that was extended to cover the period 2010-
2020 [28,29]. Indeed, African Nations are aligning to these

international plans to pull efforts of promoting TM uses
including developing robust policies and legislatives. Further,
many African countries are signatories to the TRIPs 1994, CBD
1998, and Nagoya Protocol 2010, which require governments
to put mechanisms for recognition and protection of the vast
available local knowledge and associated used genetic materials
including those in TM. This is the commendable direction
taken in addressing the rights of traditional knowledge holders
whom for centuries have transmitted this knowledge orally
thus continued exposing the region in a risk of biopiracy and
that some knowledge became forgotten or lost during oral
transmission. The ethnobiomedical information originating
from African culture could be appropriately coordinated and
disseminated through formal training and research to bring
about reliability and allow adoption for sustainability of the
TM services that benefit the majority of the SSA population.
Notably, only a few apprenticeships and formal training can
be traced in SSA.
METHODOLOGY
The current review intends to appraise the trend and situation of
African TM education training curricula in SSA as one element
in the integration process in the formal health-care system.
Analytical methodology used for this appraisal was through
internet search from Google, Google Scholar, PubMed, HINARI,
ISI, Global health training center, and Popline (K4 Health)
database using the terms or key words: Curriculum or courses,
or program in traditional or herbal medicine in Africa alone and
combination. In additional terms such as degree, college, SSA,
or country names were used in combination with the search
titles. A manual evaluation of searched titles and reference lists
of relevant studies and reviews was also conducted. Furthermore,
all articles related to the subject were selected and web-link
or the authors’ affiliation to view the institutional webpage
whether they offer any course or training program in TM. Basic
courses or program in phytochemistry, pharmacognosy, natural
products chemistry, and phytomedicine are not included in this
appraisal because it is a science of the materia medica without
necessarily having a reflection on two key characteristic aspects
of TM, that is, practices accompanied with the use of materia
medica.
RESULTS RETRIEVED
The analytical review of the information related to the
subject on “curriculum or courses, or program in traditional
or herbal medicine in Africa” revealed only a few institutions
mostly universities or colleges in the countries residing
SSA that undertake training in TM or complementary and
alternative medicine [Table 1]. Many of the retrievable
information indicated TM training to be tailor-made short
courses geared to develop professional skills for a specific
community of professionals. Furthermore, noted that,
funds for most of the short courses were donor-based thus
not sustainable beyond funding period, e.g., the Multi-
disciplinary University Traditional Health Initiative project
of South Africa. Some private owned colleges do conduct
J Intercult Ethnopharmacol ● 2016 ● Vol 5 ● Issue 3
Innocent: Trends and challenges of integration of TM
alternative and complementary medicine education training
such as homeopathy as shown in Table 1. Most of the TM
education programs in public universities are geared at
analyzing the efficacy, safety, and quality of TM products
while the clinical practices were being mostly left to private
sector entities. Notably, several universities and research
institutions in SSA countries are running some basic courses
in phytochemistry, pharmacognosy, natural products chemistry,
and phytomedicine. However, those universities/colleges are
not listed as they are out of the scope of the present appraisal.
DISCUSSION
Previously Chitindingu et al., 2014 pointed out the training
components in African TM that was offered in South Africa
to have a theoretical approach rather than problem-solving
approach [32]. Further, reports indicated difficulties in the
initial stages of introducing TM curriculum in biomedical
universities for undergraduates [4,30,32,33]. Nevertheless,
the importance of TM in SSA call for setting priorities of
developing medicines from materia medica while streamlining
TM practices alongside with other health professional training
and services. There only only limited huddles on TM products
that are used in treatments as many are crude extracts or are
in the form of raw materials containing the therapeutic active
ingredients [34]. Some may have been used for centuries by
individuals within their environment in the communities, and
their efficacy and safety is well-known by the entire community
and may be acceptable. These can be a good start-up that may
proceed to be essential medicines to be streamlined in formal
health system delivery services if they satisfy the health care
needs of the majority of the population and the prescribers
are made aware of their efficacy and safety. The few African
countries that have managed to integrate TM products in the
National Essential Medicine List such as Ghana is because
it was able to develop curriculum which is used to train TM
experts as the way of disseminating the indigenous medical
knowledge and practices to several health professionals [35].
Several African countries such as South Africa, Sierra Leone,
and Tanzania have TM products being sold over the counters
facilitated by the research and training programs undertaken
in these countries [30,31,32,36-39].
FUTURE PROSPECTS AND RECOMMENDATIONS
Notably, few on-going attempt to integrate TM in formal health
care can be spotted in some SSA countries whereby collaborative
initiatives of some Traditional Health Practitioners Organization
such THETA-Uganda; TAWG-Tanzania; and ZINATHA-
Zimbabwe work closely with the Ministry of Health in addressing
the prevention and care of HIV/AIDS patients [40,41]. These
attempts are good model toward integration of TM to the
formal system if embraced by formal training of practitioners
that participate in such collaboration. The training program will
instill skills and confidence to Traditional Health Practitioners
to work in partnership with modern doctors in the existing
formal health system. Other areas that need improvement
in the integration process are modernization of TM to allow
3
Innocent: Trends and challenges of integration of TM

Table 1: Some universities and colleges in Sub-Sahara Africa that offer formal education training in traditional medicine
*Country *Institution
Ghana The Kwame Nkrumah University of
Science and Technology, Department
of Herbal Medicine
University of Ghana, Department
of Pharmacognosy and Herbal
Medicine
Endpoint homeopathic training
institute
The college of integrated medicine
University of Ibadan, College of
Medicine
Kenya Kenyatta University, Department
of Pharmacy and Complementary/
Alternative Medicine
University of Nairobi, Department of
Pharmacology and Pharmacognosy
Sierra Leone University of Sierra Leone,
Department of Pharmacognosy and
Phytochemistry
South Africa University of KwaZulu-Natal,
The Department of Science and
Technology-National Research
Foundation Centre
University of the Western Cape
South African, Herbal Science and
Medicine Institute
College of Natural Therapies
Blackford Centre for Herbal
Medicine
Tanzania Muhimbili University of Health
and Allied Sciences Institute of
Traditional Medicine
Department of Veterinary Medicine,
Sokoine University of Agriculture
*Listed universities/colleges are not exhaustive rather most retrievable list from SSA countries with curricula in traditional medicine. SSA: Sub-Sahara
Africa
Academic program or course offered
Bachelor of Science Degree in Herbal
Medicine
A Course for Bachelor of Pharmacy
Diploma and Degree in Alternative
Medicine
Program in Complementary Health Care at
Certificate Level
Training Curricula for Undergraduate
Courses for Undergraduate and Graduate
Pharmacy
Master of Science in Pharmacognosy and
Complementary Medicines Course
Masters Degree Program in Traditional
Medicine
Pharmacy
Courses in Traditional Medicine For
Pharmacy Medical Undergraduate
IKS Research and Postgraduate Training in
Traditional Medicine
Postgraduate Programs in Herbal Medicine
Tailor-made short courses geared to develop
professional skills for a specific health
professionals community, e.g., courses for
Clinical trials in herbal medicine
Postgraduate and Co-graduate Educational
Programs
Diploma in Medical Herbalist
Postgraduate (MSc and Ph.D.) Program in
Traditional Medicine Development
Module for Undergraduate and Graduate
Medical Students
Master of Science in Natural Products
Technology and value addition
Citation
https://www.knust.edu.gh/admissions/
prospective/ugprogrammes
http://pharmacy.ug.edu.gh/overview
http://www.endpointcollege.com/
https://www.villagevolunteers.org/village-news/
ghana-college-of-integrated-medicine/
http://www.wahooas.org/spip.php?article1017
http://medicine.ku.ac.ke/
index.php/department/
pharmacy-and-complementary-medicine
http://pharmacology.uonbi.ac.ke//uon_
degrees_details/733
[30,31]
http://aiks.ukzn.ac.za/about-dst-nrf-ciks
https://www.uwc.ac.za/Faculties/NS/SAHSMI/
Pages/Programmes.aspx#.UMBzYqyxhP4
http://www.collegeofnaturalhealth.co.za/
http://www.studyonline.co.za/herbal/enrol.php
http://www.muhas.ac.tz/index.php/academics/
muhas-institutes/110-itm
http://itm.muhas.ac.tz/index.php/
training-programmes
http://www.suanet.ac.tz/index.php/education/
programmes-offered-at-sua

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I thank THETA-Uganda for inviting me to deliver a keynote
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the work is properly cited.
Source of Support: Nil, Conflict of Interest: None declared.
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